disability benefits system; organizational health and wellness conference, sept. 19, 014

Val LougheedNorthern Lights Canada

Real Work * Real People * Real Results

Organizational Health and Wellness: A Strategic

Approach

The Disability Benefits System

1-800-361-4642 * www.northernlightscanada.ca * vlougheed@northernlightscanada.ca

“You don’t want your impairments to define you – you want them to inform you.”

(Hanita Dagan, personal communication, 2005)

www.slideshare.net/vlougheed

#NLCAN

www.northernlightscanada.ca/about/about-val-

lougheed/be-still

Agenda

•Beginning …

•Middle …

•End …

Rated PG-113

People Strongly Cautioned!

May contain bad language, brief nudity, sexual overtones, and drug usage.

Beginning

My Story

Sept. 9, 2003 - morning

Sept. 9 – p.m.

Sept. 15 2003 – Jan. 19 2004

Journey Back to Life

February 2004 – Present

Starting Point

The

Re-organization

of Self

2003 --

Middle

The Disability Benefits System

OVERALL GOALDelivery System

Efficiency

•Recovery and Return to Work as quickly as possible

•Benefits provided at minimum cost

(Rand Report; Reville et al, 2005)

WHAT I NEEDED

• Return to Work Services

• Financial Compensation

ASSESSMENTS

WHAT I GOT• Physio

• Myofascial Release Massage

• Psychological Support

• Head Injury Program

• GRTW

• Financial Compensation

The Lynchpin

The Medical Model

Impairment

Predicts

Disability

BUT

enesis

DISABILITY PARADOX

PERSONAL OUTCOMES

“people are indirectly compelled to remain inactive and assert they are incapable of working in order to continue to receive payments”.

(OECD, 2009, p. 17)

FINANCIAL OUTCOMES

•

HIDDEN COSTS

•

WHY

enesis

#1 --IATROGENESIS

Over Diagnosis and Medicalization of

Factors

#2 -- Work Disability

Work Disability

“People who never lose time from work have better outcomes than people who lose some time from work.”

• odds of a worker ever returning to work drop by 50 percent by 12th week

(ACOEM , 2006, p. 6)

#3 -- Interactions Between Injured

Workers and Insurers (Kilgour et al, 2014; Miller, 2001)

Losing My Grip

My IWRPAugust 2004

SCARF MODEL (Rock, 2008)

LOOKS LIKE

Non-compliance

Malingering

Faking severity of impairment

Doesn’t want to work

Wants to cheat the system

SYSTEM-INDUCED DISABILITY

“benefits system itself has a disabling effect on people”

(OECD, 2009, p. 17)

REWIND

George Engel (1913-1999)

It’s more important to know

what sort of person has a

disease than to know what sort of disease a person

has.(Hippocrates, circa 460 – 377 BC)

Biopsychosocio(economic) Model

Lennart Nordenfelt (1945--)

Nordenfelt on Disability

Only has meaning when associated with action and placed in context

► doing something, somewhere

► must understand the something and the somewhere

(Nordenfelt, 2003)

DISABILITY IS NOT A MEDICAL CONCEPT

Impairment

does not Predict

Disability(ACOEM, 2006; De Paolo, 2013; Franche et al,

2005; Loisel, 2009; Nordenfelt, 2003; Prigatano, 1999; Waddell, 2010; Wright,

1992)

End

Future Directions

Bell Aliant Halifax

Accept and Assist

vs.

Deny and Defend

(Burnstein, 2014)

A New (Fantastical)Return to Work Benefits System

Focus on interaction between person and

society

FUNCTIONAL FACTORS

Person

Environment

System

PERSON ENVIRONMENT

SYSTEM

The Lynchpin

The Role of the Physican

“shift away from complete reliance on physician certification for work absences (Certificate of Disability) to co-operation between the employee and his or her employer with the use of medical input, advice and support”

(CMA, 2001, p. 1)

RETURN TO WORK TEAM

• Person

• RTW Co-ordinator

• Employer

• Insurer• Union Rep, Health Care Provider, Therapist(s), etc .

►role of each stakeholder is calibrated to match up more effectively with the situation at hand(Davis, Badii & Yassi, as cited in Franche et. al., 2005, p. 533)

Calibration of Roles

“where workplace and worker involvement should be high, and healthcare provider involvement more modest”

(Franche et. al., 2005, p. 533)

•focus of involvement centres around work-site based interventions

(Davis, Badii & Yassi, as cited in Franche et. al., 2005, p. 533)

Results of this Approach

• Gross Absence Rate (unscheduled absences : scheduled working

time) (‘09) 4.5% -- 3.6% (‘13) • SDB as % salary (STD payments : total payroll)

(‘09) 1.36% -- 0.99% (‘13)

• Denials ~ 1% - usually wrong basket • Grievances on denials – rare • Relationship with Union - positive• # of Health Assessments – increased (some referred

by Union)• # of IMEs for SDB adjudication – rare• # of IMEs for HA’s and SDB mgmnt - frequent*

(Burnstein, 2014)

REAL SAVINGSPersonal and Financial

1. Understand ‘Disability’

2. Positive Regard

3. Trust

TRUSTTRUST ▲

꞊

TIME ▼ +

COST ▼

(Covey, 2006)

Back in “a” SaddleSeptember 2007

• Officially change role/ title

• Re-organize NL

• Home office

Northern Lights Canada is a person-centred organization committed to providing innovative, responsive links to real work.

We offer 4 major divisions of service: • Vocational Rehabilitation Services • Employment Services • Employer Services• Corporate Training

For more information, please contact us: 1-800-361-4642

www.northernlightscanada.ca

Voc Rehab Canada (VRCAN) is a national consortium of experienced regional vocational rehabilitation companies. VRCAN provides customers with single-point access to VR services anywhere they are needed in Canada, whether on an individual service or contract basis.

Member companies include:Argus Management Consultants,

Inc. Sandra Preeper & Associates

Advantage Rehabilitation Consultants Ltd.

Rehabilitation Alternatives Limited / Vocational Alternatives Software

OPTIMA Rehabilitation CVE Inc.

Northern Lights Canada Occupational Rehabilitation Group of Canada (ORGOC)

Western Rehabilitation Specialists Inc.

Diversified Rehabilitation Group

Genesis Rehabilitation Ltd. Rehabilitation FocusFor more information, please feel free to contact us at 1-800-361-

4642